Nicotine Replacement Therapy

Nicotine Transdermal Patch

The nicotine transdermal patch is the most popular of all of the NRT choices and is available over the counter. The adhesive patch is attached directly to the skin in a location below the neck and above the waist. It is replaced once per day and delivers a continuous level of nicotine over the 18 to 24 hours for which it is worn. Over-the-counter doses are available in 21 milligrams per day (mg/day), 14 mg/day, and 7 mg/day, though research has been done with doses as high as 63 mg/day. Typical duration of treatment is 6 to 10 weeks, with some brands recommending a gradual tapering regimen and others combining a single dose with abrupt termination. While stopping patch use too early has been associated with a greater risk of relapse following termination in some studies, other findings indicate no benefit in continuing use beyond 8 weeks. Patches are also the safest form of NRT for individuals with stable cardiovascular disease due to the constant level of delivery of nicotine.

Side effects of the nicotine transdermal patch most frequently involve skin irritations at the site of the patch and disrupted sleep, vivid dreams or [Page 650]nightmares, or insomnia. The user is directed to move the location of the patch each day and to wash the area thoroughly after removing the patch to reduce the impact on the skin area. To address the sleep disturbances sometimes associated with patch use, the consumer can choose to wear the patch for only 16 hours, removing it before bed. As there is no current research indicating superiority of the 24-hour versus the 16-hour patch, removal before attempting to sleep can maintain the effectiveness while reducing this side effect.

Nicotine Lozenge

The nicotine lozenge is available over the counter in doses of 1 mg, 2 mg, and 4 mg per piece. The lozenge is placed between the gum and the cheek and dissolves, delivering the nicotine to the bloodstream. The lozenge will take about 20 to 30 minutes to dissolve, and it is recommended that consumers use at least nine per day for the first 6 weeks, tapering off by the 12th week. Common side effects include upset stomach or indigestion (especially if the lozenge is swallowed), hiccups, sore teeth and gums, throat irritation, headaches, and excessive flatulence.

Nicotine Gum

Nicotine gum delivers nicotine in a manner similar to the lozenge. The 2-mg or 4-mg over-the-counter piece is chewed a few times until the nicotine is released, and then it is placed between the gum and the cheek. The consumer repeats this process for up to a half hour, when chewing no longer releases the peppery taste associated with nicotine delivery. Typical use of the gum involves 10 to 15 pieces per day used for 1 to 3 months, and chewing too few pieces or stopping use too soon is associated with relapse.

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